Hemorrhoids and anal sex

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Dear Dr. Myrtle

I think I’ve developed hemorrhoids as a consequence of anal sex. Help!

It is uncommon for people to develop hemorrhoids because of anal sex. Why? Because people who enjoy comfortable anal penetration have good conscious control of their anal muscles and pelvic floor muscles, and thus are better at relaxing at the time of a bowel movement. Straining during bowel movements and chronic anal muscle tension are more likely to cause hemorrhoids than anal penetration is. Perhaps this will come as a surprise to you, but anal massage is often helpful to persons who have hemorrhoids because it helps them decrease tension in the musculature, and promote healthy blood circulation.

If you are developing hemorrhoids because of anal sex, I’d advise caution. Your technique needs attention, and you need more information. Chronic muscular tension as well as a lack of relaxation with anal play can cause a break in the anal cushions, padded areas that protect the muscles and blood vessels from the stress of evacuation (passing stool). If the cushions become disturbed, they can puff up and split, allowing blood vessels to pop through either internally (internal hemorrhoids) or externally (external hemorrhoids). These blood vessels can then break (a bleeding hemorrhoid); clot (a painful purple hemorrhoid); or regress, leaving a small skin tag.

Anal penetration before complete relaxation can be the "too much tension" that causes hemorrhoids. Other causes include chronic anal muscular tension, constipation, and generalized stress. You may not be aware of this, but many people are chronic holders of tension in the muscles surrounding their anus, which can be quite an uncomfortable condition. (This is really no joke if it happens to you ...)

If you have experienced new hemorrhoids, do not allow any anal penetration by someone else (at all) until you’ve healed. Most health care providers recommend "sitz baths" - baths where you soak your anus - two times a day for one to two weeks (depends on how quickly you heal). Gentle massage of the anal opening during the bath may improve blood circulation and healing. Other techniques as you are healing include gentle anal massage with lubricants and latex or polyurethane gloves (so you’re less likely to tear the skin with a hangnail), along with meditation focused on relaxing the pelvic floor muscles.

J. Morin’s Anal Pleasure and Health has a nice section on care of hemorrhoids in a later part of the book, which I highly recommend for you to read. Another helpful book is The Ultimate Guide to Anal Sex for Women, which has accessible information for both women and men interested in the topic. Take care.

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